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Takotsubo cardiomyopathy following envenomation: An updated review
Ajay K Mishra1, Anu A George2, Kevin John John3
1Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States. ajay.mishra@stvincenthospital.com.
Insights
Envenomation, particularly from bee stings and scorpion bites, can trigger Takotsubo cardiomyopathy (TTC). Most patients experience acute coronary syndrome symptoms and apical TTC, with significant recovery after medical management.
Area of Science:
- Cardiology
- Toxicology
- Emergency Medicine
Background:
- Takotsubo cardiomyopathy (TTC) mimics acute coronary syndrome (ACS) and can be precipitated by various factors.
- Envenomation is a rare but documented cause of TTC.
Purpose of the Study:
- To review the patterns, mechanisms, and outcomes of TTC induced by envenomation.
Main Methods:
- Systematic review of studies on TTC and envenomation published before June 2022.
- Inclusion criteria required a confirmed diagnosis of TTC and a history of envenomation.
Main Results:
- Twenty patients with envenomation-induced TTC were identified, most commonly from bee stings, scorpion stings, and snake envenomation.
- Commonly postulated mechanisms include fear, anxiety, direct catecholamine toxicity, and beta-adrenergic agent administration.
- 95% presented with ACS symptoms, 72% showed apical TTC on echocardiography, and 94% improved with management.
Conclusions:
- Insect stings and reptile bites can precipitate TTC, with bee and scorpion stings being the most frequent culprits.
- Fear, anxiety, and stress are key mechanisms.
- Patients typically present with ACS symptoms, elevated troponin, and apical TTC, showing good recovery with medical treatment.
Background:
Takotsubo cardiomyopathy (TTC) can be diagnosed in patients presenting with clinical features of acute coronary syndrome (ACS) by using Mayo clinic criteria. Multiple precipitators have been attributed to causing TTC. Rarely it has been reported to occur following an acute envenomation.
Aim:
This review describes the various patterns, mechanisms, and outcomes of envenomation induced TTC.
Methods:
In this review, we included all studies on "TTC" and "envenomation "published in the various databases before June 2022. To be included in the review articles had to have a distinct diagnosis of TTC and an envenomation.
Results:
A total of 20 patients with envenomation induced TTC were identified. Most episodes of envenomation induced TTC were reported following a bee sting, scorpion sting, and snake envenomation. Fear and anxiety related to the sting, direct catecholamine toxicity and administration of exogenous beta-adrenergic agents have been commonly postulated to precipitate TTC in these patients. 95% of these patients presented with a clinical picture of ACS. Most of these patients also fulfill at least 3 out of 4 criteria of Mayo clinic criteria for TTC. Echocardiographic evidence of Apical TTC was noted in 72% of patients. 94% of these patients had clinical improvement following optimal management and 35% of these patients were treated with guideline directed medications for heart failure.
Conclusion:
Envenomation following multiple insect stings and reptile bites can precipitate TTC. Most reported envenomation related TTC has been due to bee stings and scorpion bites. Common mechanisms causing TTC were fear, anxiety, and stress of envenomation. Most of these patients present with clinical presentation of ACS, ST elevation, and elevated troponin. The most common type of TTC in these patients is Apical, which improved following medical management.
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